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Abstract

Objective: The obesity paradox was originally described by Horwich et al. and is a paradoxical decrease in mortality with increasing body mass index (BMI) in patients with cardiovascular disease. The aim of this study was to analyze the impact of BMI on outcomes of lower extremity(LE) endovascular interventions.

Methods: A prospective registry was maintained including all patients who underwent LE interventions between 2004–09.Patients with BMI measurements at the time of surgery were categorized into underweight(UW <18.5),normal(18.5–24.9),overweight(OW 25.0–29.9) and obese(≥30.0),based on the WHO classification. Kaplan Meier and Cox regression analyses were used.

Result: A total of 2236 lesions were treated in 991 patients.There were 18 UW,382 normal,387 OW and 204 obese patients. Mean age in obese 67.7±10.4 and OW 71.7±10.3 was less than in UW 73.4±11.5 and normal 73.8±11.2.Obese and OW groups had a higher percentage of males and diabetics (P<.05).The UW group had higher mean lesion length 104.6±102.1mm,stenosis 90.5±13.3% and multilevel disease 33.3% as compared to other groups. Mean follow-up was 15.8±14.7 months.Primary, primary assisted, secondary patency, limb salvage and survival rate were significantly lower in normal and UW patients as compared to OW and obese.After controlling for diabetes,sex,ESRD,smoking,lesion length and stenosis, obesity was associated with improved secondary patency (HR=.56; 95% CI, .44-.72 P<.001), limb salvage (HR=.28 95% CI.15-.53 P<.001) and survival rate(HR=.55; 95% CI .31-.99 P=.04) as compared to normal.

Conclusion: In conclusion, UW and normal BMI patients had significantly lower patencies, limb salvage and survival rate than OW and obese patients. The paradox may be partially explained by the presence of a more severe and extensive form of peripheral arterial disease in low BMI patients at the time of presentation. Further studies are needed to explain the obesity paradox in this patient population.